menstrual bits

Question 1

primary amenorrhoea

Answer 1

failure to establish menstruation by 15yrs of age in girls with normal secondary sexual characteristics (such as breast development)

OR

by 13yrs of age in girsl with no secondary sexual characteristics

Question 2

causes of primary amenorrhoea

Answer 2

commonest cause = gonadal dysgenesis - turners

testicular feminisation
congenital malformations of genital tract

functional hypothalmic - secondary to anorexia
congenital adrenal hyperplasia
imperforate hymen

Question 3

management of primary amenorrhea

Answer 3

ix + treat underlying cause

primary ovarian insufficiency due to gonadal dysgenesis (turners) is likely to benefit from hormone replacement therapy
(to prevent osteoporosis)

Question 4

dysmenorrhoea

Answer 4

excessive pain during the menstrual period

primary = no underlying pelvic pathology, excessive endometrial prostoglandin production is partially responsible, periods have always been like this

secondary = develops after many years of menarche, result of underlying pathology

Question 5

features + mx of primary dysmenorrhoea

Answer 5

pain starts just before or within a few hours of period starting
- suprapubic cramping pains which may radiate to back or down thigh

mx
- NSAIDs - mefanamic acid (inhibit prostaglandin production)
- COCP 2nd line

Question 6

causes of secondary dysmenorrhoea

Answer 6

endometriosis
adenomyosis
PID
copper coils
fibroids

** refer all pattients with 2nd dysmenorrhoea to gynae for ix **

Question 7

heavy menstrual bleeding (menorrhagia) investigations

Answer 7

FBC !

routine transvag US if symptoms:
- intermenstrual/postcoital bleeding
- pelvic pain
- pressure symptoms

Question 8

management of heavy menstrual bleeding

Answer 8

no contraception
- mefenamic acid 500mg or tranexamic acid 1g tds
–> both started on 1st day of period

contraception
- IUS mirena = 1st line
- COCP
- long act progestogens (depo-provera)

(Norethisterone for rapidly stop heavy bleeding)

Question 9

short term management to rapidly stop heavy menstrual bleeding

Answer 9

norethisterone 5mg tds !!

short term option to rapidly stop heavy menstrual bleeding

Question 10

Mittelschmerz

Answer 10

refers to abdominal pain assoc with ovulation
- mid-cycle pain

sudden onset pain of either iliac fossa -> generalised pelvic pain
- self-limiting, resolves within 24hrs

Question 11

management of mild premenstrual syndrome

Answer 11

lifestyle advice
- sleep, exercise, smoking

regular, frequent (2-3hrly), small, balanced meals rich in complex carbohydrates

Question 12

management of moderate premenstrual syndrome

Answer 12

new-generation COCP

Question 13

management of severe premenstrual syndrome

Answer 13

a SSRI
- may be taken continously or just during luteal phase (days 15-28)